Clinical importance of microalbuminuria in diabetes and hypertension.

Numerous studies document an almost linear association between the level of albuminuria and risk for a cardiovascular event. Recent data also demonstrate a strong association between the presence of microalbuminuria and elevations in C-reactive protein. Therefore, the increased membrane permeability that generates microalbuminuria might be secondary to an inflammatory process. Progression from microalbuminuria to macroalbuminuria indicates worsening of vascular disease and presence of kidney disease. Recent pharmacologic interventions have resulted in significant delay and even arrest of progression of microalbuminuria to macroalbuminuria as well as kidney disease progression. Therefore, focus should be placed on use of antihypertensive agents that not only lower blood pressure but also lower or normalize albuminuria levels. All recent guideline statements support the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Further lowering of albuminuria may be achieved by adding verapamil, diltiazem, or an ARB to an ACE inhibitor.